Organization
CARDIOVASCULAR DISEASES OF NILES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUNDATHAJE ISHWARA BHAT M.D. (PRESIDENT)
(269) 683-1120
Entity
Organization
Contact information
Practice address
24 N SAINT JOSEPH AVE, SUITE A, NILES, MI 49120-2263
(269) 683-1120
(269) 683-4325
Mailing address
24 N SAINT JOSEPH AVE, SUITE A, NILES, MI 49120-2263
(269) 683-1120
(269) 683-4325
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
42240
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0601110821
BCBS MI
MI
05
—
101365131
—
MI
Enumeration date
03/21/2008
Last updated
05/06/2008
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